An estimated 65% of nursing home admissions are suffering from dementia, although little is known about their medical outcomes and the extent to which their dementia is responsible for the use of costly nursing home and acute care resources. The proposed study is designed to: 1) estimate the prevalence of dementia in new admissions to a diverse set of 44 nursing homes containing a mix of patients similar to those in U.S. nursing homes; 2) provide descriptive information about the medical comorbidities, functional dependencies, and social supports of demented vs. non-demented nursing home admissions; 3) compare the mortality and morbidity of demented vs. non-demented admissions during the year following admission; and 4) determine the unique role of dementia on the use of nursing home and acute care resources for this group. A prospective design will be used. All individuals (N=2250) aged 65 or older admitted to a 23% stratified random sample of nursing homes (N of homes=44) in Maryland during a one year period, who were not resident in a nursing home during the previous 12 months, will be identified and enrolled. The 44 nursing homes have already been selected and participated in 3 NIA funded projects. Within 30 days of admission, information about patient health and functional status will be obtained from family proxies, nursing home staff and nursing home charts. Patients will be administered a series of neuropsychological tests. The determination of dementia will be made by an expert panel of neurologists and psychiatrists following DSM- III-R criteria, after review of information collected by trained evaluators from multiple sources. Incidence of major medical morbidity (infections, pressure sores, falls, febrile episodes), will be obtained from medical charts during the 1-2 year follow-up. Mortality and nursing home and acute care use will be monitored through administrative records for 1-2 years following admission. This study overcomes many shortcomings of earlier studies of nursing home populations in that: 1) it focuses on demented persons admitted to nursing homes; 2) it will evaluate and follow a first admission cohort to a representative, statewide sample of nursing homes; 3) patients will be assessed directly by research staff and the designation of dementia will be made by an expert clinical panel following standard diagnostic criteria; and 4) patients will come from facilities varying in level of care, bed size, ownership, and location.